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S5 - Principles III - Test 4 > Peds Fluid Management > Flashcards

Peds Fluid Management Flashcards

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1
Q

T/F Children have small surface area to volume ratio

A

False

Large surface area to volume ratio

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2
Q

T/F kids have immature homestasis mechanisms

A

true

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3
Q

What electrolyte abnormalities are common in kids?

A

Hyper and hyponatremia

Hyper and hypokalemia

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4
Q

Why is pediatric intraop fluid mgmt especially important?

A

Children overload and dehydrate easily

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5
Q

Considerations if giving large amounts of IV fluids

A

Need to warm them

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6
Q

Consideration with patient on TPN

A

Continue perioperatively to prevent hypoglycemia

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7
Q

What age group should you always use volumetric chambers, micro-drips and/or pumps?

A

Children <10 years old

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8
Q

What two IV fluids can you use with blood products?

A

NS or plasmalyte

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9
Q

What fluids should you use for maintenance and 3rd space losses?

A

Non-glucose crystalloids

(LR, NS, plasmalyte)

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10
Q

What electrolyte abnormality can occur with “old” PRBCs?

A

Hyperkalemia

More common if giving more than one blood volume

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11
Q

Is it appropriate to give platelets if your patient looks a bit oozy but you don’t have any labs?

A

No

Give for dilutional thrombocytopenia or documented decreased platelet count

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12
Q

What blood product do you give for dilutional coagulopathy or surgical “oozing”?

A

FFP

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13
Q

What all is considered a colloid?

A

Albumin

Hetastarch

Blood products

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14
Q

What are some other options besides banked blood for high blood loss procedures that you would prob have to prepare in advance for?

A
  • Autologous donation
  • Directed donors
  • Cell saver
  • Deliberate hypotension
  • Normovolemic hemodilution
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15
Q

Is is okay to ride out a low Hct in a healthy, hemodynamically stable patient if they are done losing blood?

A

Yas

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16
Q

Signs of acute hypernatremia

A
  • Irritability
  • Coma
  • Seizures
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17
Q

Treatment for hypernatremia

A

Colloid or NS bolus with slow correction of Na+

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18
Q

Signs of acute hyponatremia

A
  • HA
  • Nausea
  • Weakness
  • Confusion
  • Irritability
  • Seizures
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19
Q

Signs of advanced hyponatremia

A
  • Respiratory arrest
  • Irreversible neurologic injury
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20
Q

Treatment for hyponatremia

A

Slow correction for asymptomatic cases

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21
Q

Treatment for acute hyponatremia

A

Rapid correction

~except this causes central pontine myelonolysis?? so SOS~

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22
Q

Causes of acute hyperkalemia

A
  • Renal insufficiency
  • Massive tissue trauma
  • Acidosis
  • Succinylcholine with myopathies, burns, motor neuron disease
  • Sepsis
  • Massive transfusion
  • MH
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23
Q

EKG changes with hyperkalemia

A
  • Peaked T waves
  • Prolonged PR
  • Wide QRS
  • Eventual sinusoidal
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24
Q

Treatment for hyperkalemia

A
  • IV Ca++
  • Bicarb for acidosis
  • Glucose/insulin
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25
Q

Causes of acute hypokalemia

A
  • Vomiting
  • Diarrhea
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26
Q

Signs of hypokalemia

A
  • muscle weakness
  • Prolonged QT
  • Dampened T waves
  • U waves
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27
Q

Treatment for hypokalemia

A

oral supplements if possible or slow IV correction

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28
Q

What are some reasons for fluid loss intraop?

A
  • Surgical blood loss
  • Surgical trauma/capillary leaking protein movement into interstitial space (3rd space)
  • Anesthesia–> vasodilation –> relative hypovolemia
  • Direct evaporation
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29
Q

If your patient loses 300 ccs of blood how much crystalloid would you give to replace it?

How much colloid would you give?

A

450-900 crystalloid

300 colloid

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30
Q

Excessive amounts of NS given can cause what electrolyte/ acid base imbalance?

Would this occur with LR also?

A

Hyperchloremic acidosis

Does not occur with LR

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31
Q

What is a situation where excessive amounts of NS may be given because LR is not an option?

What other fluid could you use in this situation?

A

With massive transfusion

You can use plasmalyte with blood to avoid hyperchloremic acidosis

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32
Q

Why cant you use LR with blood products?

A

Ca++ binds to citrate and causes emboli

33
Q

Two definitions of massive blood transfusion in children

A
  1. Replacement of one or more blood volumes
  2. Replacement of >30 ml/kg in <4 hours
34
Q

What type of blood should you use in emergency until crossmatched blood is available?

A

O-

Or O+ in males???

35
Q

Do you use damage control approach in children

A

Idk but it has not been fully studied

36
Q

What is the usual reason for MBT-induced coagulopathy?

A

Dilution

Other causes: fibrinolysis, DIC

37
Q

Do you use the fixed ratio of 1:1:1 for blood products on children?

A

Also not fully researched in children so unsure

38
Q

What occurs to platelets when 2-2.5 blood volumes are lost?

How to prevent?

A

Significant thrombocytopenia and further bleeding

  • Consider platelet transfusion after 1-1.5 blood volumes
39
Q

What is a good determinant of platelet needs?

A

Starting platelet count

40
Q

What occurs when replacing 1-1.5 blood volumes lost with PRBCs and fluids?

Recommendations to prevent?

A

Loss of clotting factors

  • Consider FFP after 1 BV
  • Give FFP after 1 BV loss than 1 FFP: 2 PRBCs
  • Check coags after ever BV loss
41
Q

Recombinant Factor VII (Novo VII) is FDA approved for Hemophilia and congenital factor VII deficiency…

Considerations for off label use in children?

A

Caution in use for children with surgery or trauma induced bleeding

Should only be used for life-threatening bleeding

42
Q

Is TXA an early or late choice for bleeding in children?

A

Early

43
Q

What should you suspect in children with ongoing bleeding with normal pre-op coags and platelet count?

How to treat?

A

DIC

Treat the cause (shock, acidosis, sepsis)

44
Q

What increases risk of hyperkalemia with PRBCs admin?

A
  • Increased PRBC shelf time
  • Irradiation
  • Fast rate of admin
45
Q

T/F hyperkalemia is less likely to occur if blood given at slow rate through peripheral IV

A

True

46
Q

Most common reasons for hyperkalemia during massive blood transfusion

A
  • Tissue injury
  • Rapid transfusion
  • Acidosis (poor perfusion)
  • Hypothermia
  • Hypocalcemia
47
Q

EKG signs of hyperkalemia in massive blood transfusion

A
  • Ventricular dysrhythmias
  • Peaked T waves
48
Q

Treatment of hyperkalemia

A
  • Calcium
  • Hyperventilation
  • Bicarb
  • Albuterol
  • Glucose/insulin
49
Q

Major considerations for large blood loss

A
  • Anticipate blood loss
  • Transfuse early
  • PIV if possible
  • Minimize use of “old” blood especially if irradiated
50
Q

EKG signs of hypocalcemia and/or citrate toxicity

A
  • Widened QRS
  • Prolonged QT
  • Peaked T waves
51
Q

How to treat documented acidosis?

A

Bicarb duh

52
Q

Idk how to word this but dont let your patient get cold when youre giving them all these blood products- treat hypothermia aggressively

A

kk

53
Q

What two POC tests are growing in popularity?

A

TEG and ROTEM

54
Q

Maintenace IV fluids need for patient under 10 kg?

A

4 ml/kg/hr

55
Q

Maintenance IV fluids need for a 4 kg babe

A

16 ml/hr

56
Q

Maintenance fluids needed for 10-20 kg kid

A

40 + 2 ml/kg for each kg over 10

57
Q

Maintenance fluids needed for a 14 kg tot

A

48 mls/hr

58
Q

Maintenance fluids for kid >20 kg

A

60 + 1 ml/kg for each kg > 20

(or just weight in kg + 40 = mL/hr)

59
Q

Maintenance fluids for a 35 kg kid

A

75 mls/hr

60
Q

How to calculate fluid deficit?

A

Deficit = Hours NPO x Maintenance rate

61
Q

What is the fluid deficit for a 32 kg kid that has been NPO for 6 hours?

A

432 mls

62
Q

How much fluid is lost to 3rd space in mild level of tissue trauma?

Aka insensible, small incision, scopes

A

3-4 ml/kg/hr

63
Q

How much fluid is lost to 3rd space in moderate level of tissue trauma?

AKA ortho, large incision

A

5-7 ml/kg/hr

64
Q

How much fluid is lost to 3rd space in extensive level of tissue trauma?

AKA open abdominal or spinal case

A

>10 ml/kg/hr

65
Q

EBV for preterm bby

A

100 ml/kg

66
Q

EBV for full-term baby to 12 month old

A

90 ml/kg

67
Q

EBV for 12 months to 3 years

A

80 ml/kg

68
Q

EBV for toddler to 8 years

A

75 ml/kg

69
Q

EBV for > 8 years old

A

70 ml/kg

70
Q

How much does 10-15 ml/kg PRBCs increase your Hgb

A

2-3 g/dL

71
Q

How much blood would it take to raise a 30 kg kids Hgb from 22 to 25?

A

~450 mls of PRBCs

30 kg x 15 = 450

(can use 10-15 ml/kg for 2-3 increase in hgb)

72
Q

Calculate MABL for a 6 year old that weighs 22 kg and has a starting Hct of 36

A

~504 mls

73
Q

How do you divide up the fluid deficit among the hours of surgery?

A

Replace 1/2 in the first hour

1/4 in the second and third hour

74
Q

What is the max amount of fluid the patient should recieve in an hour?

Exception?

What do you do with the leftover?

A

Do not exceed 20 ml/kg/hour

Exception is if you are replacing blood loss

Roll over the leftover that you couldnt replace to next hour

75
Q

What is the max amount of fluid a 22 kg patient can get in 1 hour if they arent bleeding?

A

440 mls

76
Q

the EKG shows the following:

  • peaked T waves
  • long PR interval
  • widened QRS

what do you suspect?

A

hyperkalemia

77
Q

the EKG shows the following:

  • prolonged QT
  • dampened T waves
  • U waves

what do you suspect?

A

hypokalemia

77
Q

the EKG shows the following:

  • prolonged QT
  • dampened T waves
  • U waves

what do you suspect?

A

hypokalemia

78
Q

the EKG shows the following:

  • wide QRS
  • prolonged QT
  • peaked T waves

what do you suspect?

hint you’re giving bunches of blood

A

hypocalcemia and/or citrate toxicity w/ MTP

S5 - Principles III - Test 4 (7 decks)

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